The results of a national audit part funded by Diabetes Ireland Research Alliance, a subsidiary of Diabetes Ireland have been published in this months Irish Medical Journal.  The aim of this study was to describe the provision and quality of diabetes services for children with type 1 diabetes in the Republic of Ireland, and to establish a baseline from which services and outcomes might be improved.

Diabetes Ireland welcomes this report which simply reiterates our understanding of the current state of diabetes paediatric care in Ireland. Current diabetes paediatric services are severely under resourced, unstructured and un-coordinated with the standard of care a child with Type 1 diabetes receives depending on the geographic location of the family and the tenacity of his/her parents in trying to obtain the best medical care for their child.

Every child/young adult should have access to insulin pump therapy, if clinically deemed to be beneficial. Yet many Irish children are being deprived of access to this therapy. Structured education for the family to help them come to terms and learn how to effectively manage the condition is not available throughout most of the country. This is not a difficult thing to provide and all we see in our ongoing relations with the HSE are obstacles being put in the way.

The audit illustrates that children with Type 1 diabetes are not getting 3 month reviews (internationally clinically recommended). This is a particular concern in the existing larger centres with the audit showing these centres are less likely to see the children every 3 months.
The audit also raises concerns about the level of glycaemic control which increases with the age of the child. Internationally, it has been shown that the level of glycaemic control is related to the resources in the diabetes centre and only 1 centre in Ireland is adequately resourced.

While we do agree there needs to be regionalisation of services, in areas of large geographical spread, such as in the North West, Mayo and Cork/Kerry, we do feel that outreach services from these centres of excellence to a local service will provide far greater support to families. We would also see GPs, trained in the management of rapid diagnosis and sick day management as being a vital cog in a structured service so that they can effectively look after routine illnesses in people with Type 1 diabetes.

These 2,518 young Irish people with Type 1 diabetes will be utilising our health services for the rest of their lives and inadequate support now will see poor long term glycaemic control which is only going to increase the healthcare burden for these people in future years at more cost to the taxpayer.

Overall, we strongly welcome the report and would urge the HSE and the Minister for Health to look at developing and implementing a uniform standard of service with agreed clinical protocols so our children and families, regardless of location, get the support and care they deserve. Diabetes Ireland will be taking up these issues with the relevant bodies to ensure this gets done. 

This audit study was part funded by Diabetes Ireland Research Alliance, a subsidiary of Diabetes Ireland.

* A full copy of the report can be found in this months edition of the Irish Medical Journal, page 6 onwards: http://www.imo.ie/news-media/publications/April-2014-IMJ.pdf